Partially Hydrolyzed Guar Gum Attenuates the Severity of Pouchitis in a Rat Model of Ileal J Pouch-Anal Anastomosis

We aimed to evaluate the efficacy of treatment with partially hydrolyzed guar gum (PHGG) using a rat model of ileal pouch-anal anastomosis and pouchitis. In the J pouch groups, tissue myeloperoxidase activities were significantly higher than native myeloperoxidase activities (P = 0.020; P = 0.015; P = 0.004, respectively). A statistically significant difference in total histological score was detected in the J pouch + 5% dextran sulfate sodium (DSS) group, compared to the J pouch control and the J pouch + 5% DSS + PHGG groups (P < 0.01 and P < 0.01, respectively). There was a significant overgrowth of aerobes and anaerobes in the J pouch + 5% DSS group. This study demonstrated that rectal administration of PHGG attenuates the severity of pouchitis in a rat model. In conclusion, PHGG may be an additional therapeutic strategy for the treatment of pouchitis.     

Utility of flexible fiberoptic bronchoscopy for critically ill pediatric patients:A systematic review

AIM: To investigate the diagnostic yield, therapeutic efficacy, and rate of adverse events related to flexible fiberoptic bronchoscopy(FFB) in critically ill children. METHODS: We searched Pub Med, SCOPUS, OVID, and EMBASE databases through July 2014 for English language publications studying FFB performed in the intensive care unit in children 18 years old. We identified 666 studies, of which 89 full-text studies were screened for further review. Two reviewers independently determined that 27 of these studies met inclusion criteria and extracted data. We examined the diagnostic yield of FFB among upper and lower airway evaluations, as well as the utility of bronchoalveolar lavage(BAL). RESULTS: We found that FFB led to a change in medical management in 28.9%(range 21.9%-69.2%) of critically ill children. The diagnostic yield of FFB was 82%(range 45.2%-100%). Infectious organisms were identified in 25.7%(17.6%-75%) of BALs performed, resulting in a change of antimicrobial management in 19.1%(range: 12.2%-75%). FFB successfully reexpanded atelectasis or removed mucus plugs in 60.3%(range: 23.8%-100%) of patients with atelectasis. Adverse events were reported in 12.9%(range: 0.5%-71.4%) of patients. The most common adverse effects of FFB were transient hypotension, hypoxia and/or bradycardia that resolved with minimal intervention, such as oxygen supplementation or removal of the bronchoscope. Serious adverse events were uncommon; 2.1% of adverse events required intervention such as bag-mask ventilation or intubation and atropine for hypoxia and bradycardia, normal saline boluses for hypotension, or lavage and suctioning for hemorrhage. CONCLUSION: FFB is safe and effective for diagnostic and therapeutic use in critically ill pediatric patients.     

Fine Needle Aspiration Cytology Utility in Salivary Gland Tumor Diagnosis

We aimed to improve the diagnostic accuracy of tumors by using immunocytochemistry (IHC) on destained smears to correlate the cytological findings with histopathology and/or IHC for final evaluation of results. We have done a randomized and prospective double-blind study. Forty-six clinically suspected patients of salivary gland tumor were enrolled for study. Those with non-neoplastic\ inflammatory salivary gland pathologies and swellings other than salivary gland origin were excluded from the study. The Fine needle aspiration cytological (FNAC) diagnosis of all the patients was compared with the corresponding histopathology. Sensitivity and specificity of FNAC in diagnosing malignancy were 91.3 and 100 %. Diagnostic accuracy of FNAC for malignant tumors was 95.65 %. In our study kappa value came out to be 0.88 (p value <0.00), which indicated an excellent agreement between histological and cytological typing of salivary gland tumors. FNAC is a highly sensitive and specific technique for diagnosis of salivary gland tumors. Histopathology however is the gold standard for diagnosis, classification and grading of tumors. Immuno-cytochemistry can act as adjuvant in diagnosing salivary gland tumors, however it did not help in improving the diagnostic accuracy of FNAC in our study. Considering an excellent agreement between cytology and histology, a type specific diagnosis can be reached on FNAC of salivary gland tumors.     

The significance of neutrophil-to-lymphocyte ratio in idiopathic epiretinal membrane

Purpose

To assess the levels of neutrophil-to-lymphocyte ratio (NLR) in patients with idiopathic epiretinal membrane (iERM) and to compare the NLR results of patients with iERM and healthy controls.

Methods

This retrospective study enrolled 43 patients with iERM and 40 healthy subjects. Complete ophthalmologic examination and complete blood count measurements were performed of all subjects. Complete blood counts were performed within 2 h of blood collection.

Results

There was a significant difference in NLR between iERM and control groups (p < 0.01). The receiver operating characteristics analysis revealed that the value of NLR to distinguish patients with iERM and controls was found to be 0.832. The best cutoff value was 1.90, with a sensitivity of 72% and specificity 70%.

Conclusions

Our study for the first time provides evidence that subclinical systemic inflammation may cause or at least accompanies iERM using a novel biomarker NLR.

     

Thoracic Re-irradiation for Locally Recurrent Lung Cancer

Background: Patients with recurrent or progressive lung cancer experience a significant symptom burden, negatively affecting quality of life and reducing life expectancy. Thoracic re-irradiation can be used for palliative treatment to relieve symptoms or as a curative treatment. Methods: Using patient charts, we identified and reviewed 28 cases that had received palliative thoracic re-irradiation for recurrent lung cancer. Results: Before re-irradiation, 32% of patients had stage III non-small cell lung cancer and six had small cell lung cancer. The median interval between treatments was 18.7 months. Median follow-up was 31.2 months from the initial radiotherapy and 5 months after re-irradiation. A better performance status before re-irradiation (80, p=0.09) and a lower overlap 90% isodose (70, p=0.09) showed trends toward improved survival. Grade 1-2 toxicity from re-irradiation was recorded in 12/28 patients, and no grade 3 or 4 acute toxicity was encountered. Conclusion: The role of palliative treatment in survival is not clear but it can provide symptomatic relief in patients, with no high grade toxicity. Further studies with greater patient numbers and longer follow-up times should facilitate determination of the role of this treatment in toxicity and effects on survival.     

Hydroxyurea in Sickle Cell Disease: Our Experience in Western India

Sickle cell disease (SCD) is common in tribal belt of Gujarat, but not addressed effectively as it should be with effective use of Hydroxyurea, supportive care and counseling. In our single centre study of 70 patients of SCD who were only on Folic acid and Blood transfusion support, were analyzed and followed up for 1 year in terms of their clinical symptoms, Blood transfusion requirement, laboratory parameters before and after Hydroxyurea therapy. We found statistically significant improvement in clinical symptoms and positive changes in laboratory parameters studied. This validates the well established role of Hydroxyurea in SCD as seen in the various international trials. Hence it is imperative that the well documented benefits of Hydroxyurea in various International studies should be translated into clinical practice. SCD should be treated like a chronic disorder needing preventive therapy in form of Hydroxyurea and counseling with regular follow up.     

Is Post-discharge Rehabilitation Timing Associated with 90-Day Readmission in Primary Total Joint Arthroplasty?

HSS Journal ® - Physical therapy (PT) is an accepted standard of care after total joint arthroplasty (TJA) and essential to maximizing joint functionality and minimizing complications that...     

Defining and characterizing sustained remission in patients with rheumatoid arthritis

The objective of this study is to characterize stability and clinical features of patients with rheumatoid arthritis (RA) in sustained remission. Combination therapy with methotrexate and tumor necrosis factor inhibitors (TNFi) has increased remission rates in RA but optimal regimens to maintain remission are unknown. We describe Study of Etanercept And Methotrexate in Combination or as Monotherapy in Subjects with Rheumatoid Arthritis (SEAM-RA) and data from a run-in period of longitudinal observation. Patients in Simplified Disease Activity Index (SDAI) remission (score ≤?3.3) receiving etanercept and methotrexate were screened and had to maintain remission over 3 run-in visits/24 weeks before randomization to combination therapy or withdrawal of etanercept or methotrexate. Baseline characteristics were examined for predictive factors for maintaining remission. As of November 2016, 141 patients have enrolled; of these, 64 have been randomized, 34 were ineligible after run-in, and 43 are in run-in period; 70% have completed run-in. Enrolled and randomized patients, respectively, had mean (standard deviation [SD]) disease duration 11.0 (8.6) and 12.6 (9.7) years; mean (SD) duration of etanercept use 4.2 (3.8) and 4.9 (4.2) years; mean (SD) methotrexate dose 15.9 (4.8) and 15.5 (4.9) mg/week; and mean (SD) SDAI scores 1.5 (0.9) and 1.4 (0.8). At enrollment, 73% and 63% were in Boolean remission based on 28 joints and 66/68 joints, respectively. No enrollment characteristic predicted successful completion of run-in. Two-thirds of patients considered to be in remission at enrollment sustained remission through 24 weeks. Baseline characteristics of enrolled patients and those who completed run-in were comparable.